A placental polyp is a polypoid or pedunculated mass or fragment of placental tissue retained in the uterine cavity for an indefinite period of time after abortion or partuition. These retained fragments of placental tissues, especially the hypervascular types, are common causes of vaginal bleeding in the puerperium, or occasionally, months or years after abortion or partuition, and may cause profuse hemorrhage. It is rare with an incidence of < 0.25% of all pregnancies. Despite its rarity, it is potentially life threatening, and high clinical suspicion and prompt and early diagnosis is essential, as well as an accurate diagnosis of neovascularisation to prevent hemorrhagic complications. We present four cases of hypervascular placental polypoid masses wherein thorough history taking and physical examination, in conjunction with serum ?-HCG levels and transvaginal ultrasonography with Color Doppler findings led to the prompt diagnosis of this clinical entity. Pelvic ultrasound with Doppler imaging is the most useful initial test for a suspected hypervascular lesion, because it distinguishes tissue with abundant vascularity from that with little or no blood supply. Other useful diagnostic procedures include Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) angiography. Successful conservative management of placental polypoid masses by methotrexate administration, hysteroscopic resection, and uterine artery embolization (UAE) have been reported. Hysterectomy is reserved for patients with intractable vaginal bleeding and patients who are no longer desirous of future pregnancies. Hysteroscopic resection was successfully done in two cases presented, while the other two patients underwent hysterectomy.

Human ; Female ; Adult ; Pregnancy ; Uterine Artery Embolization ; Methotrexate ; Computed Tomography Angiography ; Conservative Treatment ; Hysterectomy ; Abortion, Spontaneous ; Uterine Hemorrhage ; Postpartum Period ; Polyps ; Early Diagnosis

Background: Major changes in the practice of medicine have been adopted due to the COVID-19 pandemic and have not spared the practice of ultrasound among obstetrician–gynecologists, considered to have higher risk due to unique attributes of an ultrasound examination. Objectives: This study evaluated the awareness, attitudes, perceptions, and practices of the obstetric–gynecologic sonologists in the country during the pandemic, including the use of telesonography. Methodology: A descriptive, cross-sectional survey was conducted through a self-administered, structured questionnaire using an online survey software. Results: There were 120 respondents with postresidency training in ultrasound (54.2%) or in maternal and fetal medicine (43.3%), practicing in different regions, and mostly with teaching affiliations (56.7%). Most are aware of the guidelines on the practice of ultrasound this pandemic and they perceived themselves to be especially vulnerable to the infection. They admitted having feelings of stress, sadness, and depression, and their concerns centered on being infected and potentially transmitting it to their family. These perceptions translated to specific practices that include use of level 3 personal protective equipment, patient screening, triaging, and use of physical barriers to minimize environmental and contamination. While most are consistent with guidelines, some practices are neither based on sound scientific evidence nor correctly adhered to, including noncompliance with appropriate ultrasound transducer cleaning and disinfection. Regarding telesonography, only half of the respondents had good knowledge, with most having informal sources of information on the technology. Although the respondents have a good attitude toward it, only a few (15.8%) admitted to using it, mainly to confer with an expert or colleague (38.3%), and for teaching purposes (11.7%). Conclusions Obstetric–gynecologic sonologists in the Philippines are aware of the risks and have the same attitudes and perspective on COVID-19 infection as other health-care providers. Specific practices have been modified; however, the use of telesonography is not among the changes adopted.
Obstetrics ; Telemedicine